| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
332 |
332 |
$14K |
| V2020 |
Frames, purchases |
454 |
454 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
273 |
273 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
210 |
210 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
57 |
57 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
82 |
$1K |
| 92310 |
|
13 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |